Fibromyalgia is a complex pain syndrome that is multifactorial in the generation of symptoms. Current ideas on etiology favor the development of a central pain sensitization state that is driven by nociceptive impulses from muscle and other soft tissues. The resulting state of chronic pain leads to physiologic arousal that in turn generates many of the symptoms that are characteristic of the total syndrome. The secondary symptoms due to physiologic arousal are often amenable to modification through the techniques of cognitive behavioral therapy. Multidisciplinary education in the areas of sleep hygiene, pacing, aerobic exercise, stretching, stress reduction, and therapeutic options provides fibromyalgia patients with more control and enhances their interaction with clinicians. Multidisciplinary group treatment programs are ideally a complement to individualized therapy, not a substitute.
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